A common cause of lower back and leg pain is a ruptured or herniated disc. Patients usually complain of dull or sharp pain, cramping, muscles spasms and in some cases sciatica and leg weakness

Anatomy

In between each of the five lumbar vertebrae (bones) is a disc which resembles a hard fibrous shock-absorbing pad. At the end of each vertebra are endplates which hold these discs in place. Each individual disc has a tire-like outer casing called the annulus fibrosus. This structure holds inside a gel like substance which is called the nucleus pulposus.

Nerve roots exit the spinal canal through small passageways between the vertebrae and discs. If the disc pushes into the spinal canal or against the nerves than you will experience pain.

Disc herniation occurs when the annulus fibrous breaks open or cracks, allowing the nucleus pulposus which is the gel like centre to escape. This is called a Herniated Nucleus Pulposus (HNP) or herniated disc.

Most disc herniation occurs in section L4 and L5, the L5 nerve trapped by the herniated disc causes back pain and tingling sensations down to the buttocks and legs.

When will the pain subside?

Approximately 90% of people with this condition return to normal activities within 2 months but some patients can take as long as 6 months to recover. The goal of the different treatment options is to reduce irritation of the nerve thereby reducing pain so that you can quickly return to your usual activities.

Non surgical options for herniated disk

1. Pain control

Decreased activity.

It is advised that 1 or 2 days of complete bed rest on a firm mattress may reduce symptoms significantly. Some patients find lying on the floor more comfortable. It is advised to limit sitting up in bed and bending, however this can be quite an ordeal for active people who are not used to staying in bed for long periods of time! Do not spend more than 2 days in bed as it may prolong healing.

TENS

Electrical stimulation. Transcutaneous electrical nerve stimulation (TENS)

A TENS unit provides small electrical currents to selected areas of the nerves. This current is not painful and reduces pain by stimulating endorphins (pain inhibiting molecules) which help to lower the pain sensation. This is an effective treatment for back pain.

View the Tens Machine

Pain medications

Medication such as Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to reduce pain and inflammation. NSAID such as ibuprofen reduce inflammation of the nerve roots and make everyday life more comfortable. You should seek advice for from your doctor before you start any medication.

Corticosteroids

If your pain does not significantly improve with NSAID then your doctor may prescribe you Corticosteroids. The doctor may inject Corticosteroids into the spinal nerves to reduce severe inflammation. There are obvious dangers to inject into the spine which should be discussed with your doctor. No more than three injections are given to a patient.

Cold or heat therapy

Reusable hot and cold packs than can either be microwaved or frozen can reduce your back pain. It is advised to use these reusable packs rather than ice as the application of ice directly on to the skin could cause ice burns.

You may wish to check with your doctor before using heat in the first 48 hours of the condition as increased blood flow can cause swelling and inflammation in some patients.

View the reusable hot and cold pack for back pain

Back Brace

A supportive back brace helps you maintain a good posture and alignment which reduces spinal tension and decreases pressure on the affected discs. The majority of patients benefit from a back brace to reduce pain and increase warmth to the soft tissues of the back.

Two recommended supports are the Vertebrace or the Vulkan Back Brace

Vertebrace

Vertebrace spinal supports are used to support the lumbar vertebrae and the muscles of the lower back.
It provides firm, comfortable support to help relieve back pain.

Vertebrace is made from a strong, elastic, woven material with built-in stiffeners.

Vertebrace spinal supports provide firm, comfortable support for the lower back.

Reinforced panels in the lumbar region provide additional local support.

View the Vertebrace

Vulkan Back Brace

Provides significant levels of lumbar support for those recovering from a severe episode of back and/or leg pain. The additional support stays in place and the compression strap helps to limit unwanted twisting and bending movements to allow damaged structures to recover without strain. It is ideal for those with occupations which involve heavy lifting and carrying.

View the Vulkan Back Brace

Hydrotherapy

Hydrotherapy involves doing stretching or walking inside a swimming pool. This will help reduce pain and promote muscle relaxation. This is useful for people that wish to start being active without aggravating their back pain. Buoyancy jackets or other aids help you to keep afloat in the water which reduces pressure on the back.

These Buoyancy jackets can be used for for hydrotherapy, learning to swim or for just additional buoyancy in the water. They are ideal for hydrotherapy exercises to recover from a back injury.

View the Buoyancy Swim Jacket

Traction

Traction will be carried out under the supervision of a physical therapist and involves the use of a traction machine to stretch the back. This can reduce lower back pain, muscle spasms and pressure on the herniated discs.

2. Restore function

When the pain is significantly reduced the patient can start the process of stabilizing and strengthening the back.

Exercise and physical therapy

Physical activity is essential for a speedy recovery as it allows the patient to not only reduce pain but also prevent any future incidences of this condition.

A physical therapist can recommend or perform stretching exercises that can significantly improve your back pain. These should only be carried out when the acute pain has subsided. Ask your physical therapist about the McKenzie manoeuvres.

Dynamic lumbar stabilization exercises

Rehabilitation and future prevention of this condition needs to be orientated around strengthening both your abdominal and your back muscles. This is known as dynamic lumbar stabilization and should only be done under the supervision of a physical therapist.

Aerobic exercises

You may be able to participate in activities such as walking, biking, swimming or elliptical machine workouts to help control pain. Which exercises help your back pain will be specific to you. Start with a small amount of activity, such as five to 10 minutes and add minutes in the days that follow. Your goal is to comfortably work up to 30 to 40 minutes of aerobic exercise.

When non surgical treatments fail

If you try non surgical treatments but don't experience improvement after a period of time, you may need to consider surgery more seriously. Experts don't agree on a specific time frame for considering surgery, but many suggest waiting four to six weeks after the onset of pain, unless you have the signs or symptoms listed above. Where you fall within this range may depend on several factors, including how much the pain interferes with your daily activities, sleep, work and recreation.